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La toxémie gravidique |
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DEFINITION:
10 % des femmes enceintes présentent au cours de la grossesse des chiffres tensionnels supérieurs à 14/9
La moitié d'entre-elles sont atteintes d'HTA essentielle, l'autre moitié d'une toxémie gravidique càd d'une HTA d'origine placentaire. Toutes doivent bénéficier d'un étroite surveillance. Une HTA essentielle peut évoluer vers une toxémie gravidique.
TOXEMIE GRAVIDIQUE : UNE MALADIE DU PLACENTA REVELEE PAR L'HTA
Par cette hypertension, l'organisme maternel tente de compenser une mauvaise perfusion du placenta pour protéger le foetus. Le problème n'est donc pas de soigner l'HTA - qu'il est peut être même préférable de respecter - mais d'éviter à la mère et l'enfant la survenue de complications.
Elle reste une cause importante de mort et de complications materno-foetales.Il faut savoir la distinguer de l'hypertension arterielle essentielle ( assez souvent prééxistante mais pouvant être révélée ou découverte par la grossesse).
Voir également : Pré-éclampsie ( Signes d'alertes)
LE DIAGNOSTIC DIFFERENTIEL : HTA ESSENTIELLE OU TOXEMIE
Il va conditonner l'essentiel de la CAT
- Classiquement, maladie de la première grossesse mais un nouveau "Papa" peut être en cause !
- Le premier repère est l'âge de la grossesse. Généralement, une toxémie gravidique ne s'exprime qu'à partir du 5ème mois.
- Dans tous les cas une protéinurie supérieure à 300 mg/24 heures et/ou une uricémie augmentée sont révélatrices mais une normalité n'exclut pas le diagnostic à 100 %.
- L'échographie avec doppler des artères ombilicales et utérines est l'examen signicatif et le plus précoce; avant le retard de croissance. Il permet d'en prédire la survenue.
VIGILANCE ET REPOS:
La découverte d'une toxémie gravidique fait redouter les complications du 3ème trimestre : crise d'éclampsie, mort foetale, CIVD, hématome rétroplacentaire et déclenche le seul traitement possible : la césarienne en urgence !
Le repos est dans la majorité des cas le seul traitement suscepetible de prévenir ou de retarder l'heure des complications.
Surveillance Clinique Outre la TA, le poids la recherche d'oedème ( ++ mains et face ) et elle nécessite la collaboration de l'obstétricien ( Monitoring, Sage femme à domicile, Echographies, Hospitalisation,... )
Le traitement ( cf infra) n'est instauré que si la TA dévient menaçante pour la mère : > 16/9.
Il est important de notifier aux parturientes de ne pas instaurer un régime sans sel ( comme le Grand Père !!!)
Il peut être conseillé l'achat d'un tensiomètre
PRE - ECLAMPSIE:
Des signes cliniques imposent l'hospitalisation d'urgence.
La patiente et son entourage doivent en être informés ++ et immédiatement contacter le MG, l'obstétricien voire le SAMU
- Douleurs épigastriques en barre
- Céphalées, obnubilation
- Phosphènes, accouphènes
A l'examen, tous les signes de toxémie sont en augmentation ( TA, Uricémie, protéinurie, oedèmes)
Voir également : Pré-éclampsie
ET APRES.... Sauf anomalies, aprés l'accouchement, l'enfant bénéficie de la même surveillance que n'importe quel NNO
Pour la mère, il convient de contrôler la TA pendant 3 mois. Si elle ne baisse pas, outre le traitement, une recherche étiologique doit être envisagée
Lors des futures grossesse l'administration systématique de 100 mg/J du 3ème au 8ème mois améliore significativement le poids des bébés à la naissance.
Pathologie de la première grossesse, généralement les suivantes se passent mieux et même peuvent être normales.
sources: http://www.esculape.com/
Date de création : 06/02/2005 @ 14:22
Dernière modification : 07/02/2005 @ 10:50
Catégorie : GROSSESSE
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